No treatment without consent, says judge.

A dramatic example of the prominence of informed consent in medico-legal comes from Britain. A 62-year-old woman who has suffered from paranoid schizophrenia for most of her life has refused to allow doctors to amputate a gangrenous leg. Her instructions were upheld by a judge who said that choice is “a part of what it means to be human” and that an unwanted operation would be “criminal assault”.

The story of the unnamed woman began with a superficial foot infection in December. The wound swiftly became gangrenous and eventually the foot “fell off”. Doctors wanted to amputate her leg, but the woman refused. They appealed to the Court of Protection to order an operation which would save the woman’s life.

Despite her psychological disability, the woman was living a reasonably independent life and held down a responsible job. Mr Justice Peter Jackson said that she was intellectually capable of making an informed decision.

“Anyone capable of making decisions has an absolute right to accept or refuse medical treatment, regardless of the wisdom or consequences of the decision. The decision does not have to be justified to anyone. In the absence of consent, any invasion of the body will be a criminal assault. The fact that the intervention is well-meaning or therapeutic makes no difference…

“The right to decide whether or not to consent to medical treatment is one of the most important rights guaranteed by law. The temptation to base a judgment of a person’s capacity upon whether they seem to have made a good or bad decision, and in particular upon whether they have accepted or rejected medical advice, is absolutely to be avoided.”

The woman is said to be reconsidering her decision to refuse a below-the-knee operation. 

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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